Lymphoma

Overview

Lymphoma is a cancer of the lymphatic system, which is part of the body's germ-fighting network.

The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect all those areas as well as other organs throughout the body.

Many types of lymphoma exist. The main subtypes are:

• Hodgkin's lymphoma (formerly called Hodgkin's disease)
• Non-Hodgkin's lymphoma

What lymphoma treatment is best for you depends on your lymphoma type and its severity. Lymphoma treatment may involve chemotherapy, immunotherapy medications, radiation therapy, a bone marrow transplant or some combination of these.

Symptoms

Signs and symptoms of lymphoma may include:

• Painless swelling of lymph nodes in your neck, armpits or groin
• Persistent fatigue
• Fever
• Night sweats
• Shortness of breath
• Unexplained weight loss
• Itchy skin

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

Causes

Doctors aren't sure what causes lymphoma. But it begins when a disease-fighting white blood cell called a lymphocyte develops a genetic mutation. The mutation tells the cell to multiply rapidly, causing many diseased lymphocytes that continue multiplying.

The mutation also allows the cells to go on living when other normal cells would die. This causes too many diseased and ineffective lymphocytes in your lymph nodes and causes the lymph nodes, spleen and liver to swell.

Risk factors

Factors that can increase the risk of lymphoma include:

• Your age. Some types of lymphoma are more common in young adults, while others are most often diagnosed in people over 55.
• Being male. Males are slightly more likely to develop lymphoma than are females.
• Having an impaired immune system. Lymphoma is more common in people with immune system diseases or in people who take drugs that suppress their immune system.
• Developing certain infections. Some infections are associated with an increased risk of lymphoma, including the Epstein-Barr virus and Helicobacter pylori infection.

Diagnosis

Tests and procedures used to diagnose lymphoma include:

• Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
• Removing a lymph node for testing. Your doctor may recommend a lymph node biopsy procedure to remove all or part of a lymph node for laboratory testing. Advanced tests can determine if lymphoma cells are present and what types of cells are involved.
• Blood tests. Blood tests to count the number of cells in a sample of your blood can give your doctor clues about your diagnosis.
• Removing a sample of bone marrow for testing. A bone marrow aspiration and biopsy procedure involves inserting a needle into your hipbone to remove a sample of bone marrow. The sample is analyzed to look for lymphoma cells.
• Imaging tests. Your doctor may recommend imaging tests to look for signs of lymphoma in other areas of your body. Tests may include CT, MRI and positron emission tomography (PET).

Other tests and procedures may be used depending on your situation.

Many types of lymphoma exist and knowing exactly which type you have is key to developing an effective treatment plan. Research shows that having a biopsy sample reviewed by an expert pathologist improves the chances for an accurate diagnosis. Consider getting a second opinion from a specialist who can confirm your diagnosis.

Treatment

Which lymphoma treatments are right for you depends on the type and stage of your disease, your overall health, and your preferences. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission.

Lymphoma treatments include:

• Active surveillance. Some forms of lymphoma are very slow growing. You and your doctor may decide to wait to treat your lymphoma when it causes signs and symptoms that interfere with your daily activities. Until then, you may undergo periodic tests to monitor your condition.
• Chemotherapy. Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. The drugs are usually administered through a vein, but can also be taken as a pill, depending on the specific drugs you receive.
• Radiation therapy. Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.
• Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.
• Other treatments. Other drugs used to treat lymphoma include targeted drugs that focus on specific abnormalities in your cancer cells. Immunotherapy drugs use your immune system to kill cancer cells. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body's germ-fighting T cells, engineers them to fight cancer and infuses them back into your body.

Alternative medicine

No supplements have been found to treat lymphoma. But integrative medicine may help you cope with the stress of a cancer diagnosis and the side effects of cancer treatment.

Talk to your doctor about your options, such as:

• Physical activity
• Art therapy
• Meditation
• Music therapy
• Relaxation exercises
• Acupuncture
• Massage

Coping and support

A lymphoma diagnosis can be overwhelming. With time you'll find ways to cope with the stress and uncertainty of cancer. Until then, you may find it helps to:

• Learn about lymphoma. If you'd like to know more about your lymphoma, ask your doctor for the details of your cancer — the type, the stage and your prognosis. Ask for good sources of up-to-date information on your treatment options. Knowing more about your cancer and your options may help you feel more confident when making treatment decisions.
• Keep your friends and family close. Your friends and family can be emotional support and provide the practical support you'll need, too, such as helping take care of your house if you're in the hospital.

• Find someone to talk with. Find a good listener with whom you can talk about your hopes and fears. This may be a friend or a family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

  Ask your doctor about support groups in your area. You might also contact a cancer organization such as the National Cancer Institute or the Leukemia & Lymphoma Society.

Preparing for an appointment

Make an appointment with your primary care doctor if you have any signs or symptoms that worry you. If your doctor suspects you have lymphoma, he or she may refer you to a doctor who specializes in diseases that affect the blood cells (hematologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For lymphoma, some basic questions to ask your doctor include:

• Do I have lymphoma?
• What type of lymphoma do I have?
• What stage is my lymphoma?
• Is my lymphoma aggressive or slow growing?
• Will I need more tests?
• Will I need treatment?
• What are my treatment options?
• What are the potential side effects of each treatment?
• How will treatment affect my daily life? Can I continue working?
• How long will treatment last?
• Is there one treatment you feel is best for me?
• If you had a friend or loved one in my situation, what advice would you give that person?
• Should I see a lymphoma specialist? What will that cost, and will my insurance cover it?
• Do you have brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Has anyone in your family had cancer, including lymphoma?
• Have you or has anyone in your family had conditions affecting the immune system?
• Have you or your family been exposed to toxins?